Clinical symptoms,comorbidities and complications in severe and non-severe patients with COVID-19: A systematic review and meta-analysis without cases duplication

Background:The pandemic of COVID-19 poses a challenge to global healthcare. The mortality rates of severe cases range from 8.1% to 38%, and it is particularly important to identify risk factors that aggravate the disease.Methods:We performed a systematic review of the literature with meta-analysis, using 7 databases to identify studies reporting on clinical characteristics, comorbidities and complications in severe and non-severe patients with COVID-19. All the observational studies were included. We performed a random or fixed effects model meta-analysis to calculate the pooled proportion and 95% confidence interval (CI). Measure of heterogeneity was estimated by Cochran''s Q statistic, I² index and P value.Results:A total of 4881 cases from 25 studies related to COVID-19 were included. The most prevalent comorbidity was hypertension (severe: 33.4%, 95% CI: 25.4%–41.4%; non-severe 21.6%, 95% CI: 9.9%–33.3%), followed by diabetes (severe: 14.4%, 95% CI: 11.5%–17.3%; non-severe: 8.5%, 95% CI: 6.1%–11.0%). The prevalence of acute respiratory distress syndrome, acute kidney injury and shock were all higher in severe cases, with 41.1% (95% CI: 14.1%–68.2%), 16.4% (95% CI: 3.4%–29.5%) and 19.9% (95% CI: 5.5%–34.4%), rather than 3.0% (95% CI: 0.6%–5.5%), 2.2% (95% CI: 0.1%–4.2%) and 4.1% (95% CI: −4.8%–13.1%) in non-severe patients, respectively. The death rate was higher in severe cases (30.3%, 95% CI: 13.8%–46.8%) than non-severe cases (1.5%, 95% CI: 0.1%–2.8%).Conclusion:Hypertension, diabetes and cardiovascular diseases may be risk factors for severe COVID-19.     

Prevalence and Risk Factors of Hypertension in Myanmar: A Systematic Review and Meta-Analysis

Hypertension (HPT) is the most common condition seen in primary care that can lead to health consequences and death if not detected early and treated appropriately.This study aimed to synthesize the prevalence, awareness, and control of HPT, and investigate the risk factors for HPT in Myanmar.We performed a meta-analysis of observational studies. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed in 3 domains: selection bias, measurement bias, and bias related to data analysis. The overall prevalence and proportions was calculated using random-effect model of DerSimonian–Laird method. To identify the risk factors for HPT in Myanmar, we entered the ratio measures of the (adjusted) effect as a log odds ratio (OR) and the standard error of the log OR using generic inverse-variance weighting method. For stability of results, we performed leave-one-study-out sensitivity analysis by omitting individual studies one at a time from the meta-analysis.Seven studies (n = 20,901) were included in this analysis. Overall prevalence of HPT in Myanmar was 22% (95% confidence interval (CI): 14%–31.7%, I²: 99.6%), stratified as 21.5% (95% CI: 14.1%–29.9%, I²: 98.7%) in men and 22.7% (95% CI: 10.8%–34.6%, I²: 99.5%) in women. Overall, prevalence of HPT increased with an advancing age of the participants. The proportions of awareness and controlled HPT were 55% (95% CI: 43%–67%, I²: 97.7%) and 11% (95% CI: 6%–15%, I²: 93.8%), respectively. A weak but significant association was observed between HPT and alcohol drinking (summary OR: 1.38, 95% CI: 1.14%–1.65, I²: 0%) and smoking (summary OR: 1.32, 95% CI: 1.0%–1.74, I²: 50%). In sensitivity analysis, when a study that made confirmation of HPT by the former World Health Organization criteria was dropped, the prevalence increased to 26% (95% CI: 20.8%–32.1%, I²: 98.1%).HPT was considerably prevalent in Myanmar, while the levels of awareness and controlled HPT were low. Health promotion strategy tailored to the education on modifiable risk factors and establishment of blood pressure screening in primary health care context would be of immense value. Upcoming well-powered studies, using the standardized research design and covering more regions of the country are recommended.     

Effectiveness of the Apparent Diffusion Coefficient for Predicting the Response to Chemoradiation Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

The efficacy of the different apparent diffusion coefficients (ADCs) in predicting different responses to preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC) is controversial. We did this meta-analysis to evaluate the efficacy of different ADCs predicting different responses to CRT in patients with LARC.We systematically searched the MEDLINE, Embase, and Cochrane Library databases for articles published from January 1, 1990, to June 3, 2014. Pooled estimates were calculated using a bivariate random-effects model for the ADCs before and after CRT (pre- and post-ADC), as well as the change between the pre- and post-ADC (ΔADC). The values of the 3 ADCs for judging different response endpoints, which were defined according to the tumor grading (TRG) system and downstaging of T (tumor) or N (nodal) stages (TN downstaging), were assessed.We included 16 studies with a total of 826 patients. The sensitivity, specificity, DOR, and AUC were 75% (95% CI 57%–87%), 70% (95% CI 50%–84%), 6.81 (95% CI 2.46–18.88), and 0.79 (95% CI 0.75–0.82), respectively, for the pre-ADC in predicting a good response; 76% (95% CI 63%–85%), 87% (95% CI 78%–92%), 20.68 (95% CI 11.76–36.39), and 0.89 (95% CI 0.86–0.91), respectively, for the post-ADC; and 78% (95% CI 65%–87%), 77% (95% CI 62%–87%), 11.82 (95% CI 4.65–30.04), and 0.84 (95% CI 0.81–0.87), respectively, for the ΔADC. The post-ADC demonstrated the highest specificity and DOR (P < 0.001), although sensitivity did not differ between the 3 types of ADC (P = 0.380, 0.192, and 0.214). For predicting a pathological complete response (pCR), the post-ADC had the highest specificity (P < 0.001and 0.030) but lowest sensitivity (P < 0.001). The ΔADC had the highest DOR; however, this difference was not statistically significant (P = 0.146).The ADC is a reliable and reproducible measure and could serve as a promising noninvasive tool for evaluating the response to CRT in patients with LARC; the post-ADC and ΔADC are particularly promising. The ΔADC had the highest diagnostic performance to predict a pCR compared with the pre-ADC and post-ADC. The value of the ADCs to predict T or N downstaging requires further investigation.     

Clinical impact of 11C-Pittsburgh compound-B positron emission tomography in addition to magnetic resonance imaging and single-photon emission computed tomography on diagnosis of mild cognitive impairment to Alzheimer's disease

This study aimed to evaluated the clinical impact of adding [¹¹C] Pittsburgh compound-B (¹¹C-PiB) PET for clinical diagnosis of mild cognitive impairment (MCI) to Alzheimer''s disease (AD) dementia.Twenty six (mean age 78.5 ± 5.18 years, 21 females) AD (n = 7), amnestic MCI (n = 12), non-amnestic MCI (n = 3), vascular dementia, progressive supranuclear palsy (PSP) with frontotemporal dementia (FTD), FTD (n = 1 each), and normal (n = 1) patients underwent ¹¹C-PiB-PET, MRI, and SPECT scanning. ¹¹C-PiB-PET was compared with MRI and SPECT for clinical impact.¹¹C-PiB-PET showed positivity in 6, 9, and 0 of the AD, amnestic MCI, and non-amnestic MCI patients, respectively, and 0 of those with another disease. Parahippocampal atrophy at VSASD was observed in 5 AD patients, 6 amnestic and PiB-positive MCI patients, 1 amnestic and PiB-negative MCI patient, and 1 vascular dementia patient. Parietal lobe hypoperfusion in SPECT findings was observed in 6, 4, and 2 of those, respectively, as well as 1 each of non-amnestic MCI, vascular dementia, and normal cases. Sensitivity/specificity/accuracy for selecting PiB-positive patients among the 15 MCI patients for ¹¹C-PiB-PET were 100% (9/9)/100% (6/6)/100% (15/15), for VSRAD were 66.7% (6/9)/83.3% (5/6)/73.3% (11/15), and for SPECT were 44.4% (4/9)/50.0% (3/6)/46.7% (7/15), while those were 88.9% (8/9)/33.3% (2/6)/66.7% (10/15)/for combined VSRAD and SPECT. ¹¹C-PiB-PET accuracy was significantly higher than that of SPECT.¹¹PiB-PET alone may be useful for selecting patients who will progress from MCI to AD in the future, although follow-up study is necessary to clarify the outcome of MCI patients.     

Treatments of unruptured brain arteriovenous malformations: A systematic review and meta-analysis

Background:The best therapeutic option for unruptured brain arteriovenous malformations (bAVMs) patients is disputed.Objective:To assess the occurrence of obliteration and complications of patients with unruptured bAVMs after various treatments.Methods:A systematic literature search was performed in PubMed, EMBASE, Web of Science, and so on to identify studies fulfilling predefined inclusion criteria. Baseline, treatment, and outcomes data were extracted for statistical analysis.Results:We identified 28 eligible studies totaling 5852 patients. The obliteration rates were 98% in microsurgery group (95% confidence interval (CI): 96%–99%, I² = 74.5%), 97% in surgery group (95%CI: 95%–99%, I² = 18.3%), 87% in endovascular treatment group (95%CI: 80%–93%, I² = 0.0%), and 68% in radiosurgery group (95%CI: 66%–69%, I² = 92.0%). The stroke or death rates were 1% in microsurgery group (95%CI: 0%–2%, I² = 0.0%), 0% in surgery group (95%CI: 0%–1%, I² = 0.0%), 4% in endovascular treatment group (95%CI: 0%–8%, I² = 85.8%), and 3% in radiosurgery group (95%CI: 3%–4%, I² = 82.9%). In addition, the proportions of hemorrhage were 2% in microsurgery group (95%CI: 1%–4%, I² = 0.0%), 23% in endovascular treatment group (95%CI: 7%–39%), and 12% in radiosurgery group (95%CI: 12%–13%, I² = 99.2%). As to neurological deficit, the occurrence was 9% in microsurgery group (95%CI: 6%–11%, I² = 94.1%), 20% in surgery group (95%CI: 13%–27%, I² = 0.0%), 14% in endovascular treatment group (95%CI: 10%–18%, I² = 64.0%), and 8% in radiosurgery group (95%CI: 7%–9%, I² = 66.6%).Conclusions:We found that microsurgery might provide lasting clinical benefits in some unruptured bAVMs patients for its high obliteration rates and low hemorrhage. These findings are helpful to provide a reference basis for neurosurgeons to choose the treatment of patients with unruptured bAVMs.     

Meta-analysis of procalcitonin as a predictor for acute kidney injury

Background:Procalcitonin (PCT) was used for predicting the development of acute kidney injury (AKI) in several studies recently. We aimed to investigate the accuracy of PCT for predicting AKI in this study.Methods:Studies that assessed the predictive performance of PCT for the development of AKI in adult patients were searched from Medline, Embase, and the Cochrane Library from inception to June 2020. We calculated the pooled sensitivities and specificities and the area under the summary receiver-operating characteristic (SROC) curves. I² was used to test the heterogeneity and the potential heterogeneity was investigated by meta-regression.Results:In total, 9 of 119 studies with 4852 patients were included, 1272 were diagnosed with AKI. In the overall analysis, the area under the SROC curve was 0.82 (95% CI, 0.79–0.85) and the pooled sensitivity and specificity were 0.76 (95% confidence interval [CI], 0.64–0.85) and 0.75 (95% CI, 0.61–0.86), respectively. In the subgroup analysis among septic patients, the pooled sensitivity and specificity were 0.59 (95% CI, 0.29–0.84) and 0.53 (95% CI, 0.31–0.74), and the area under the SROC was 0.57 (95% CI, 0.53–0.62).Conclusion:PCT may be a potential predictor for the development of AKI.     

Diagnostic accuracy of interleukin-33 for tuberculous pleural effusion: A systematic review and meta-analysis

Background:The detection of interleukin 33 (IL-33) in pleural effusion may be more sensitive in diagnosing tuberculous pleural effusion (TPE). The present study aimed to assess the accuracy of pleural IL-33 for the diagnosis of TPE by means of meta-analysis and systematic review of relevant studies.Method:After retrieving the published studies, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and a summary receiver operating characteristic curve were assessed to estimate the usefulness of pleural IL-33 in diagnosing TPE using meta-analysis with a random-effects model. We also performed meta-regression and subgroup analysis.Results:A total of 639 patients from 6 studies were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.87 (95% confidence interval [CI], 0.82–0.91), 0.76 (95% CI, 0.72–0.80), 6.54 (95% CI, 2.65–16.15), 0.17 (95% CI, 0.10–1.27), and 45.40 (95% CI, 12.83–160.70) respectively. The area under the curve was 0.94. The composition of the included population was the main cause of heterogeneity and subgroup analysis showed that pleural IL-33 had a higher specificity (0.93, 95% CI 0.87–0.96) when used for differential diagnosis between TPE and malignant pleural effusion.Conclusion:The detection of IL-33 alone in pleural effusion seems to not be an efficient diagnostic marker for TPE but may serve as a novel biomarker to differentiate between TPE and malignant pleural effusion.     

Neoadjuvant therapy of cetuximab combined with chemoradiotherapy in rectal cancer: A single-arm meta-analysis of noncomparative clinical studies and randomized controlled trials

Objective:Preoperative chemoradiotherapy combined with radical resection has reduced local recurrence rates in rectal cancer. Cetuximab shows improvement in rectal cancer treatment. But the role for neoadjuvant therapy of cetuximab combined with chenmoradiotherapy in rectal cancer remains unclear. The present study aimed to use meta-analytical techniques to assess its benefit and risk.Materials and Methods:We searched PubMed, the Cochrane Library, Embase to identify the correlational non-comparative clinical studies and randomized controlled trials (RCTs). The primary endpoints of interest were pathological complete response (pCR), complete response (CR), partial response (PR), stable disease, progressive disease (PD), R0-resection, R1-resection, and R2-resection. The secondary included any grade of toxicity.Results:Eleven investigations (9 noncomparative open-label cohort studies and 2 randomized controlled trials) involving 550 patients were ultimately included. The pooled estimates of pCR was 10% (95% confidence interval [CI]: 7%–13%, I² = 55.9%). Simultaneously, only a small amount of patients achieved CR (11%, 95% CI: 7%–15%, I² = 44.0%), which was consistent with pCR. Besides, R0 resection (93%, 95% CI: 90%–96%, I² = 16.5%) seemed to be increased but need further exploration. The safety was also calculated, and most of the toxicities were moderate.Conclusion:Neoadjuvant therapy of cetuximab combined with chemoradiotherapy could not improve pCR. The raise of R0-resection rate needed to be verified by more high-quality and well-designed RCTs. Meanwhile, the morbidity of toxicity was relatively mild and acceptable.     

Body Mass Index and Risk of Rheumatoid Arthritis: A Meta-Analysis of Observational Studies

Although many epidemiological studies have investigated the association between body mass index (BMI) and risk of rheumatoid (RA), the results have been inconsistent. Therefore, we performed a dose-response meta-analysis to quantify the dose-response association between BMI and RA risk.We systematically searched PubMed, Embase, and Web of Science databases and reference lists of articles for relevant studies published before August 2014 using terms related to BMI and RA. Fixed or random-effects models were used to estimate the pooled relative risk (RR) with 95% confidence interval (CI). Several subgroup analyses, sensitivity analyses, and publication bias tests were performed to explore potential study heterogeneity and biasThirteen studies involving 400,609 participants and 13,562 RA cases were included. The RR of RA was 1.21 (95% CI: 1.02–1.44) for obesity, 1.05 (95% CI: 0.97–1.13) for overweight. The risk of RA increased by 13% (RR: 1.13; 95% CI: 1.01–1.26) for every 5 kg/m² increase in BMI. The subgroup analyses showed a positive association between BMI and RA risk only in women with an RR of 1.26 (95% CI: 1.12–1.40) for obesity and 1.12(95% CI: 1.07–1.18) for every 5 kg/m² increase in BMI. Also, an increased risk of RA was found in sero-negative subgroup with an RR of 1.47 (95% CI: 1.11–1.96) for obesity and 1.21 (95% CI: 1.06–1.39) for every 5 kg/m² increase in BMI.There is evidence that obesity is a risk factor for developing of RA. Furthermore, the positive association between BMI and RA risk may be stronger among women than men.     

Salivary peptest for laryngopharyngeal reflux and gastroesophageal reflux disease: A systemic review and meta-analysis

Background:A rapid lateral flow test (Peptest) to detect pepsin in saliva/sputum has been considered as a valuable method for diagnosing laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD). The aim of this meta-analysis is to analyze the utility of Peptest for diagnosis of LPR and GERD.Methods:PubMed, EMBASE, and the Cochran Library (from January 1980 to 26 January 2020) were searched for pepsin in saliva for LPR/GERD diagnosis. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve data were summarized to examine the accuracy.Results:A total of 16 articles that included 2401 patients and 897 controls were analyzed. The pooled sensitivity and specificity for the diagnosis of GERD/LPR with Peptest were 62% (95% confidence interval [CI] 49%–73%) and 74% (95% CI 50%–90%), respectively. The summarized diagnostic odds ratio and area under the curve were 5.0 (95% CI 2–19) and 0.70 (95% CI 0.66–0.74), respectively.Conclusion:Peptest shows moderate diagnostic value for LPR and GERD. More studies with standard protocols should be done to verify its usefulness.     

A Systematic Review and Meta-Analysis of Medical Students’ Perspectives on the Engagement in Research

Engaging students in active learning lies at the center of effective higher education. In medical schools, students’ engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students’ perspectives on the engagement in research. We performed a systematic review and meta-analysis.Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty.A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%–11.07%; I²: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%–62.7%; I²: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%–77.9%; I²: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%–96.6%; I²: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review.Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended.     

Prevalence of Depression in Patients With Hypertension: A Systematic Review and Meta-Analysis

Prevalence estimates of depression in hypertensive patients varied widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with hypertension.Comprehensive electronic searches of PubMed, Web of Knowledge, China National Knowledge Internet (CNKI), Wangfang, and Weipu databases were conducted to identify any study in each database published from initial state to November 31, 2014, reporting the prevalence of depression in hypertensive patients. Random-effects model was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. All statistical calculations were made by using the Stata Version 12.0 (College Station, TX) and Statsdirect Version 2.7.9.We identified 41 studies with a total population of 30,796 in the present meta-analysis. The summarized prevalence of depression among hypertensive patients is 26.8% (95% confidence interval (CI): 21.7%–32.3%). Subgroup analysis shows the following results: for male 24.6%, 95% CI: 14.8%–35.9%, for female 24.4%, 95% CI: 14.6%–35.8%. For China: 28.5% (95% CI: 22.2%–35.3%); for other region (22.1%, 95% CI: 12.1%–34.1%); for community: 26.3% (95% CI: 17.7%–36.0%), for hospital: 27.2% (95% CI: 20.6%–34.5%). Estimated prevalence by interview was 21.3% (95% CI: 14.2%–30.0%); prevalence of depressive symptoms adjudicated by self-rating scales was 29.8% (95% CI: 23.3%–36.7%).The observed heterogeneity in depression prevalence of hypertension may be attributed to differences in method of evaluation. Self-report scales should be cautious of estimating the presence of depression. Thus, interview-defined depression affects approximately one third of hypertensive patients. Effective interventions for depression on patient-centered are needed.     

Histopathological Diagnostic Value of the IgG4+/IgG+ Ratio of Plasmacytic Infiltration for IgG4-Related Diseases: A PRISMA-Compliant Systematic Review and Meta-Analysis

This article aims to perform a meta-analysis to evaluate the diagnostic value of the immunoglobulin G (IgG)4⁺/IgG⁺ ratio of plasmacytic infiltration for IgG4-related diseases.Four databases—EMBASE, ISI Web of Knowledge, PubMed, and the Cochrane Library—were systematically searched. Approximately 200 participants from several studies were included in this research. STATA 11.2 software (Stata Corporation, College Station, TX) and Meta-DiSc 1.4 (Unit of Clinical Biostatistics, Ramon y Cajal Hospital, Madrid, Spain) were used to perform the meta-analysis.Nine studies were included in the meta-analysis. The pooled diagnostic odds ratio was 18.94 [95% confidence interval (CI), 2.89–124.30]. The sensitivity was 58.80% (95% CI, 50.90–66.30) and the specificity was 90.20% (95% CI, 81.20–95.80). The positive and negative likelihood ratios were 3.12 (95% CI, 1.07–9.16) and 0.26 (95% CI, 0.09–0.70), respectively. The area under the curve of the summary receiver-operating characteristic was 0.88.To conclude, the IgG4⁺/IgG⁺ ratio of plasmacytic infiltration is modestly effective in diagnosing IgG-related disease.     

Comparison between the <Superscript>13</Superscript>C-urea breath test and stool antigen test for the diagnosis of childhood <Emphasis Type="Italic">Helicobacter pylori</Emphasis> infection

Background As noninvasive tests for Helicobacter pylori infection, the ¹³C-urea breath test (UBT) and stool antigen test have been widely used. In children, however, there are few studies reporting which test shows superior performance. The purpose of this study was to compare the ¹³C-UBT and stool antigen test for their accuracy in diagnosing H. pylori infection in children.Methods A total of 123 Japanese children, ages 2 to 17 years (mean, 12 years) who underwent gastric biopsies for H. pylori infection were studied. The diagnoses included gastritis (n = 55), gastric ulcer (n = 5), duodenal ulcer (n = 20), iron-deficiency anemia (n = 7), and other conditions (n = 36). The cutoff value of the ¹³C-UBT was defined to be 3.5. The stool antigen test was performed using the HpSA enzyme-linked immunosorbent assay (ELISA) (Premier Platinum HpSA). In 16 patients who received eradication therapy, the ¹³C-UBT and HpSA were repeated 2 months after treatment.Results Based on biopsy tests, 60 children were infected with H. pylori and 63 children were not. For the ¹³C-UBT, the sensitivity, specificity, and accuracy were 95.0% (95% confidence interval [CI], 86.1%–99.0%), 98.4% (95% CI, 91.5%–100%), and 96.4% (95% CI, 93.6%–99.9%), respectively. For the HpSA, the sensitivity, specificity, and accuracy were 98.3% (95% CI, 90.8%–100%), 98.4% (95% CI, 91.2%–100%), and 98.3% (95% CI, 96.0%–100%), respectively. There were no significant differences between the performance of these two tests. In the assessment of H. pylori eradication, the results of ¹³C-UBT and HpSA agreed with those of biopsy tests.Conclusions The ¹³C-UBT and the HpSA are equally accurate for the diagnosis of active H. pylori infection in Japanese children.Kazuie Iinuma, for the Japanese Pediatric Helicobacter study Group     

Pulmonary Toxicities of Gefitinib in Patients With Advanced Non-Small-Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials

Gefitinib is a selective tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR) used to treat adults with EGFR mutation-positive non-small-cell lung cancer (NSCLC). Clinical benefits of gefitinib administration in NSCLC patients have been observed in clinical practice, but the extent of the pulmonary toxicity of gefitinib in patients with advanced NSCLC remains unclear.The aim of this systematic review was to evaluate the overall incidence and risk of gefitinib-related pulmonary toxicity in advanced NSCLC patients.Relevant trials were identified from the databases of Pubmed, Embase, Cochrane Library, and the clinicaltrials.gov of the U.S. National Institutes of Health. The outcomes included the overall incidence, odds ratios (ORs), and 95% confidence intervals (CIs). Fixed-effects models were used in the statistical analyses according to the heterogeneity of the included studies.According to the data from the included trials, the overall incidence of high-grade hemoptysis, pneumonia, pneumonitis, and interstitial lung disease (ILD) was 0.49% (95% CI: 0.24%–0.99%), 2.33% (95% CI: 1.47%–3.66%), 2.24% (95% CI: 1.34%–3.72%), and 1.43% (95% CI: 0.98%–2.09%), respectively. The pooled ORs of high-grade hemoptysis, pneumonia, pneumonitis, and ILD were 1.73 (95% CI: 0.46–6.52; P = 0.42), 0.99 (95% CI: 0.66–1.49; P = 0.95), 4.70 (95% CI: 1.48–14.95; P = 0.0087), and 2.64 (95% CI: 1.22–5.69; P = 0.01), respectively.Gefitinib was associated with a significantly increased risk of high-grade/fatal ILD and pneumonitis compared with the controls, whereas the risk of other high-grade pulmonary events (pneumonia and hemoptysis) was not significant. Careful surveillance of gefitinib-related pulmonary toxicity is critical for the safe use of this drug.     

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis

Background:There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.Objectives:To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.Data sources:We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.Methods:Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.Results:Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.Conclusions:The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.     

Fertility-preserving treatment in patients with early-stage endometrial cancer: A protocol for systematic review and meta-analysis

Background:Endometrial cancer (EC) is the second most common malignancy of the female reproductive system worldwide, and the standard treatment for early-stage EC potentially leads to permanent infertility. The objective of this study was to investigate the efficacies of different methods on fertility preservation in patients with early-stage EC.Methods:We searched the major online databases (PubMed, Embase, The Cochrane Library, and Web of Science) to collect the research literature on fertility preservation therapy in patients with early-stage well-differentiated EC aged ≤ 40 years from January 1999 to October 2019. The inclusion was performed using the R software (version R3.5.3) meta-analysis of a single rate. The efficacy of the following three fertility preservation treatments was evaluated from four aspects, the complete remission rate (CRR), recurrence rate (ReR), pregnancy rate (PregR), and live birth rate (LBR): a) taking oral progestin only therapy, b) hysteroscopic resection combined with progestin/levonorgestrel-releasing intrauterine system (LNG-IUS)/GnRH-a, c) LNG-IUS or combined with progestin/GnRH-a.Results:A total of 23 articles were included in this study, including 446 patients with early-stage EC. In the group that took oral progestin only (n = 279), CRR, ReR, PregR, and LBR were 82% (95% confidence interval [CI], 74%–92%, P = .01), 38% (95% CI, 31%-45%, P = .35), 70% (95% CI, 62%–79%, P = .68), and 63% (95% CI, 55%–73%, P = .55), respectively. Hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a therapy group (n = 96) achieved a CRR, ReR, PregR, and LBR of 95% (95% CI, 90%–100%, P = .42), 16% (95% CI, 6%–39%, P = .03), 84% (95% CI, 73%–96%, P = .39), and 72% (95% CI, 59%–87%, P = .28), respectively. LNG-IUS or combined with progestin/GnRH-a therapy group (n = 91) achieved a CRR, ReR, PregR, and LBR of 69% (95% CI, 54%–89%, P < .01), 30% (95% CI, 19%–49%, P = .36), 48% (95% CI, 18%–100%, P < .01), and 36% (95% CI, 10%–100%, P < .01), respectively.Conclusion:It is safe and effective for young patients with early-stage EC to receive oral progestin, hysteroscopic resection combined with progestin/LNG-IUS/GnRH-a, LNG-IUS, or progestin/GnRH-a.INPLASY Registration number:DOI 10.37766/inplasy2020.12.0137     

Efficacy of Xpert MTB/RIF Ultra in diagnosing tuberculosis meningitis: A systematic review and meta-analysis

Background:This study aimed to assess whether Xpert MTB/RIF Ultra (Xpert Ultra) can effectively diagnose tuberculosis meningitis (TBM) and to simultaneously compare its effectiveness with Xpert in diagnosing TBM in the same population.Methods:On August 12, 2020, Wanfang Database, China National Knowledge Infrastructure, Embase, Cochrane Library, and PubMed were searched for studies evaluating the diagnostic accuracy of Xpert Ultra for TBM. Then, we assessed the efficacy of Xpert Ultra against a composite reference standard and culture. If applicable, we also examined the diagnostic efficacy of Xpert in the same population. Heterogeneity was then explored by meta-regression, subgroup, and sensitivity analyses.Results:Six studies containing 601 specimens reported the diagnostic efficacy of Xpert Ultra for TBM, with a composite reference standard. No study had compared the efficacy between Xpert Ultra and culture. The pooled sensitivity of Xpert Ultra was 64% (95% confidence interval [CI]: 45–80), and the I² value was 86% (95% CI: 76–96); its specificity for TBM was consistently 100%. In the same population, 5 studies compared the diagnostic efficacy between Xpert Ultra and Xpert for TBM. The pooled sensitivity of Xpert Ultra and Xpert was 68% (95% CI: 46–84; I² = 87%) and 37% (95% CI: 25–50; I² = 72%), respectively. The studies were significantly heterogeneous in terms of sensitivity but not heterogeneous in specificity.Conclusions:Xpert Ultra was more sensitive than Xpert, but both were specific (100%). Therefore, Xpert Ultra had an excellent diagnostic efficacy for TBM, and it could be the preferred initial test for TBM.     

Sensitivity and Specificity of a Novel Approach to Confirm the Depth of the Endotracheal Tube: A Pilot Study

This study aimed to explore the sensitivity and specificity an approach to confirm the depth of the endotracheal tube. It was a prospective, diagnostic study (Registration number: chiCTR-TRC-14005170) conducted in the Department of Anesthesiology of West China Hospital. A total of 100 patients underwent general anesthesia were included. The distance between the upper margin of the cuff and the manubriosternal joint (CM) and the distance between the upper margin of the cuff and the carina (CC) were measured. The accuracy of the confirmed approach against fiberoptic bronchoscopy (FOB) was evaluated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. The correlation and agreement between CM and CC were explored.The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined to be 94.74% (95% CI: 87.07–98.55%), 79.17% (95% CI: 57.85–92.87%), 93.51% (95% CI: 85.49–97.86%), 82.61% (95% CI: 61.22%–95.05%), respectively. The κ value was 0.75 (95% CI: 0.60–0.90). There was a significant correlation between CM and CC (P < 0.001) with a correlation coefficient of 0.91(95% CI: 0.87–0.94). Bland and Altman plots also demonstrated a good agreement between the CM and CC. This novel method may be used to confirm the depth of the endotracheal tubes.